MAMMALIAN BITES

Question 1

Indications for Primary Closure

Answer 1

Face or scalp
Simple and appropriate for single-layer closure
No devitalized tissue
No underlying fracture
No diabetes / immunocompromise

Question 2

Management of high risk wounds

Answer 2

Cleaned
Debrided
NO closure
Dressed with non adherent dressing
Re-evaluation in 24-48 hrs

Prophylactic Antibiotics:

Amoxicillin-Clavulanate
875 mg PO bid
3-5 days

OR

metronidazole 500 mg PO q 12 hours plus doxycycline 100 mg by mouth q 12 hours
3-5 days

OR

Trimethoprim-sulfamethoxazole (160 mg/800 mg) PLUS metronidazole 500 mg PO q 12 hours

OR

Ciprofloxacin 500 mg PO q12 hours
PLUS
clindamycin 300 mg PO q 12 hours
OR
metronidazole 500 mg by mouth q 12 hours.

Tetanus prophylaxis. If uncertain whether the patient has completed a primary series or if it is more than 5 years since the last booster, give tetanus-diphtheria-acellular pertussis (Tdap) 0.5 mL intramuscular booster. If the wound is tetanus-prone, give tetanus immune globulin in addition to Tdap.

Question 3

First line antibiotic cat bite

Answer 3

Pasturella:
Amoxicillin-Clavulanate
875 mg PO bid
3-5 days

Bartonella:
Azithromycin
500 mg po od x 1 day
250 mg po od x 4 days

Question 4

First line antibiotics dog bite

Answer 4

Pasturella, Staph, Strep, Capnocytophaga:
Amoxicillin-Clavulanate
875 mg PO bid
3-5 days

Question 5

First line antibiotics human bites

Answer 5

Staph, Strep, Eikenella:
Amoxicillin-Clavulanate
875 mg PO bid
3-5 days